Dull aching back pain, which may refer into the buttock and posterior thigh and sometimes the calf and groin, often related to a twisting injury. caused by inflammation in the facet joints of the spine, linked to abnormal movement and position of the vertebrae.

Diagnosis

Back pain that is often aggravated by leaning backwards and twisting and relieved by use of ice. Movement is often limited between individual joints in the spine or in the global movement of the spine. There is often localised tenderness in the paraspinal muscles and on palpation of the vertebrae. There is an absence of positive neurological signs and there may be X-Ray signs of osteoarthritis.

Evidence based summary for manual therapy [53]

Randomised controlled research trials (RCT) and reviews (the highest current standards of scientific evidence) suggests that there is high quality evidence (on a scale of inconclusive, moderate and high) that spinal manipulation/mobilization is an effective treatment option for subacute and chronic LBP in adults [63,64,65]. There is moderate quality evidence that spinal manipulation/mobilization is an effective treatment option for subacute and chronic LBP in older adults [69]. There is also moderate quality evidence that spinal manipulation/mobilization is an effective treatment option for acute LBP in adults [63,67]. It has been found that for massage there is moderate quality evidence that it is an effective treatment for subacute and chronic LBP in adults [66,68].

Other effective non-invasive physical treatments or patient education [53]

Advice to stay active, interdisciplinary rehabilitation, exercise therapy [70,71], acupuncture, yoga, cognitive-behavioral therapy, or progressive relaxation for chronic LBP and superficial heat for acute LBP [63,66].

Back-in-Action clinical comment

Chiropractic assessment and treatment of posterior facet joint irritation is aimed at finding and reducing tension and the causes of tension in the joints and muscles. We find much of the discomfort associated with this condition arises from joint dysfunction (tension) or injury through too much movement (sprain). The joints most often involved are in the lumbar spine or the sacroiliac joints. Chiropractors usually like to address why there is an increase in stress in this area.

In our experience treating the symptoms and underlying causes of posterior facet joint irritation benefits from a combination of treatment techniques to increase the probability of a good result. Our approach often incorporates spinal manipulation, mobilisation, muscle release techniques, cranial work, back exercises (individually tailored self mobilisation, stretching and strengthening), referral for massage therapy, diet and nutritional advice, functional neurological exercises, breathing techniques, acupuncture, cryotherapy (heat and/or ice), postural improvements, foot orthotics, ergonomic advice and relaxation counselling.